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Employees Start to Feel the Squeeze of High-Deductible Health Plans

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Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#71

Post by pnutjam »

jandrewrogers wrote: post #54
duxup wrote: post #3

Earlier quoted context omitted.

How so? The choice of covering crappy plans is the employer's choice... and crappy plans are what have been pushed AFTER the ACA was passed. Largely by the GoP... Is that what the ACA was, or what someone(s) who want it to fail want? There's a weird narrative where any event is tied to the ACA while they ignore what the healthcare system is in the US overall.

The cost to employers of very good plans massively increased after ACA went into effect. When this changeover happened, I was running a company where we paid 100% for one of the best healthcare plans available in the state for both the employees and their families -- people really appreciated this benefit. This was the polar opposite of a "crappy plan", and it wasn't inexpensive to begin with. After the ACA, this pla…

What was the lifetime max on this plan? It probably would have left people out in the cold when they most needed it. I don't think it's wrong to expect insurance to cover people when they most need it, which was largely not true with million dollar lifetime caps.

Even with the ACA, employers have the best of both worlds. Expensive older people are covered by the government, and anyone who gets to expensive can be shuffled off with a little cover and the joy of "at-will" employment.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#72

Post by mieseratte »

tptacek wrote: post #38
mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

I'm not seeing the connection to the ACA in your argument. If your argument is that the ACA raised the price of health insurance, that's incorrect: health insurance premiums had been skyrocketing prior to the ACA (that crisis was what generated the political capital to pass the bill), and the ACA in fact reduced the rate of growth in health care costs.

I signed up for the ACA the year it came online. Over the years I went from a sub-$100 plan that actually covered things to paying $300+ per month for the "hit by a bus" plan that was so expensive, one year I said fuck it and paid the penalty instead. I understand well what could have been had something truly happened, but I ended up saving money paying the penalty while still having a few minor doc-in-a-box visits out-of-pocket. I also say a number of insurers go out of businesses such that now your only option in my state is the BCBS.

Say what you will about the ACA, but requiring folks to purchase a product while doing not curbing the rampant greed in the industry screams of corporate welfare to me.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#73

Post by mieseratte »

qqqwerty wrote: post #68
sithlord wrote: post #57

Earlier quoted context omitted.

In my previous career, I was an accountant, and I worked for a health insurance company, you are straight up uniformed if you do not think that ACA raised the the cost of insurance. With that said, as a type 1 diabetic, without ACA it would be impossible for me to get insurance outside of employment, so i think there is some good in it, just needs to be actually thought through, unlike what the administration did tha…

lol, You might want to take in account who you are replying to. tptacek is one of the more prolific commenters on HN. And just to be clear, he was talking about 'rate of growth` in costs, not absolute costs.

Being a "prolific commenter" does not preclude one being uninformed on a topic. Quantity != quality.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#74

Post by [deleted] »

mrosett wrote: post #17
duxup wrote: post #3

Earlier quoted context omitted.

How so? The choice of covering crappy plans is the employer's choice... and crappy plans are what have been pushed AFTER the ACA was passed. Largely by the GoP... Is that what the ACA was, or what someone(s) who want it to fail want? There's a weird narrative where any event is tied to the ACA while they ignore what the healthcare system is in the US overall.

> There's a weird narrative where any event is tied to the ACA while they ignore what the healthcare system is in the US overall. The ACA fundamentally shifted the landscape for the whole healthcare system with minimum coverage mandates (including employer plans), guaranteed issue, etc. It's also led to higher demand for medical services (ie because more people are covered - a good thing) at a time when the number of…

[deleted]

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#76

Post by bradfa »

tptacek wrote: post #4

Isn't the point of an HDHP that you're supposed to set up an HSA to go with it? Premiums for HDHPs are significantly lower than for normal health plans; the idea is that you're supposed to use the premium savings to fund the HSA, which is then money that carries over year over year, right?

Yes, one of the benefits of a HDHP is that you can use an HSA which can help since pre-tax dollars can be put directly into an HSA by your employer either as a part of your compensation package or as deductions from your paycheck (you can also make deposits with post-tax dollars and deduct them at tax time but you don't get the FICA taxes back then). Many company provided HDHP don't have THAT low of premiums and the tax savings for many middle class families is minimal due to an HSA due to the recent tax reforms providing a $2k per child tax credit.

For example, I enroll my family in my employer's HDHP. The total premiums from our plan is about $19k this year (employer pays about $14k, I pay about $5k). For this, we have $4k deductible and an $8k max out of pocket coverage. Once we hit the deductible then insurance covers 80% of the cost of most things until we hit our max out of pocket and then they cover 100% of most things, in-network. The most I can put into my HSA is $7k per year.

For about $19k/year in the NY state run insurance marketplace I could buy a HDHP with a $2k deductible and $5k max out of pocket. For $24k/year I could buy a plan that has a $35 copay for pretty much everything. My employer's plan isn't any better than what I could buy on the open market but it IS better for me because I only have to pay a fraction of the premiums.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#77

Post by defen »

tptacek wrote: post #34
defen wrote: post #25

Earlier quoted context omitted.

If it's an employer-provided plan, though, you don't generally see the premium savings. My employer provides the option (through one of the major payroll/HR providers) of a "regular" plan or a high-deductible plan, but neither choice affects my take-home pay. I still chose the HDHP though because I'm generally healthy and it lets you invest pre-tax money with no capital gains tax, which is nice.

Ok, so then, the nut of this story is that employers are adopting HDHPs as a way of reducing their own costs, but not passing the savings to employees, which defeats the purpose of HDHPs and just amounts to screwing employees over?

I'm not sure - since I have either option, I don't feel screwed over, but if an HDHP were the only option I would definitely expect to see an increase in take-home pay.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#78

Post by Someone1234 »

sithlord wrote: post #57
tptacek wrote: post #38

Earlier quoted context omitted.

I'm not seeing the connection to the ACA in your argument. If your argument is that the ACA raised the price of health insurance, that's incorrect: health insurance premiums had been skyrocketing prior to the ACA (that crisis was what generated the political capital to pass the bill), and the ACA in fact reduced the rate of growth in health care costs.

In my previous career, I was an accountant, and I worked for a health insurance company, you are straight up uniformed if you do not think that ACA raised the the cost of insurance. With that said, as a type 1 diabetic, without ACA it would be impossible for me to get insurance outside of employment, so i think there is some good in it, just needs to be actually thought through, unlike what the administration did tha…

> you are straight up uniformed if you do not think that ACA raised the the cost of insurance.

The post you replied to said:

> the ACA in fact reduced the rate of growth in health care costs.

Meaning the RATE of increase slowed. The Department of health & Human Services estimates that the ACA saved $2.3T up through 2017 ($650B in 2017 alone). Premiums haven't gone down, and they weren't estimated to.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#79

Post by pnutjam »

jseliger wrote: post #69
mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

But it's been tough for people who were already covered by employer insurance. Yes. The only word I disagree with in the headline is "start." The squeeze started years ago. One way to look at the problem is this way: http://seliger.com/2018/11/11/health-insurance-security-fqhc... : In Northern Virginia, for example, the cheapest 2019 Obamacare individual market Silver plan for a family of four (mom and dad age-40) ma…

That's not necessarily true, the discounts that insurance companies negotiate can be huge, but it's hard to include that since prices are so inflated to begin with.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#80

Post by pnutjam »

mrosett wrote: post #51
WalterSear wrote: post #37

Earlier quoted context omitted.

It's more extreme than your example. The parent is ignoring the fact his great healthcare experience is predicated on them being able to drop him the moment they could, when his illness became too expensive. Ending pre-existing conditions was the game changer in the AMA. Treating people is obviously more expensive than not treating them.

That's just not how it worked with employer insurance. Perhaps they could drop your whole company, but the insurer couldn't unilaterally cancel a single employee's plan.

No, but sick individuals, or those with sick family members are lousy employees... wink... wink..
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